In 1994, staff at the Agency for Healthcare Research and Quality (AHRQ, formerly AHCPR), developed the original Quality Indicators (QIs) as part of the Healthcare Cost and Utilization Project (HCUP). The goal was to make available a tool that could be employed by most users with access to hospital administrative data. In addition, in collaboration with the participating states, AHRQ has continued to build the State Inpatient Database (SID), which in 2000 included thirty states. States in the Mountain region of the United States, with the exception of Colorado and Utah, have to date participated in HCUP to a lesser degree than other regions. This project will build a multi-year, multi-state database of hospital discharge data from 2-3 non-HCUP states and one HCUP state with the goal of generating comparative information for the region and conducting analyses of cross-state and rural health issues. Our specific aims include: 1) Acquire a multi-year, multi-state database of hospital discharge abstract data for Nevada, Wyoming and Utah, with the possible addition of Idaho. 2) Calculate the AHRQ QI software modules (i.e. Inpatient Quality Indicators, Prevention Quality Indicators, and the Patient Safety Indicators) for the participating states and available years. 3) Make the resulting AHRQ QI indicators available for analyses of cross-state and rural health issues. 4) Evaluate the impact on the AHRQ QI from the inclusion of additional data elements and make suggestions for possible revisions and enhancements. 5) To assist western states in evaluating the relationship between the AHRQ QI and other hospital-based performance measures.